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General NPI Number Information
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NPI Number | 1275692626
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Entity Type | Individual
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Provider Name | MARGARET L MORESHEAD PA C
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Gender | Female
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 WALTER NE SUITE 204
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City | ALBUQERQUE
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State | NM
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Zip | 87102
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Country | US
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Telephone | 505-842-5518
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Fax | 505-247-8509
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Provider Business Mailing Address
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Address Line | 2041 JENSEN DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112
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Country | US
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Telephone | 505-292-5327
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Fax | 505-247-8509
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA20030024
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License Number State | NM
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